Real-Time Evaluation of CPR Performance

ABSTRACT

A computer-implemented method for providing summary information for lifesaving activities is disclosed. The method involves sensing one or more activities that are repeatedly and cyclically performed on a victim by a rescuer; identifying a cyclical timing interval over which performance is to be analyzed for a integer number of cycles of the one or more activities, and gathering data from the sensing of the one or more activities during the time interval; generating, from analysis of the one or more activities, summary data that condenses data sensed for the one or more activities into a summary of the one or more activities; and providing, for display to a user, a visual summary of the performance of the one or more activities over the identified time interval.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of and claims priority under 35U.S.C. §120 to U.S. patent application Ser. No. 13/295,781, filed Nov.14, 2011, which claims benefit of priority to U.S. ProvisionalApplication Ser. No. 61/413,336, filed on Nov. 12, 2010, entitled“Real-Time Evaluation of CPR Performance,” the entire contents of whichare hereby incorporated by reference.

TECHNICAL FIELD

This document relates to computer-based systems and techniques foranalyzing performance of a rescuer in performing CPR and other relatedlifesaving techniques.

BACKGROUND

Sudden cardiac arrest (colloquially “heart attack”) is a regular killer.The best treatment for cardiac arrest is quick and competent chestcompressions to keep blood flowing through a victim's heart. Generally,every minute of delay in treating a cardiac arrest victim lowers thechance of survival by about ten percent. As a result, the ability toprovide CPR in a competent manner can be a very important personalskill, and is particularly important for professional healthcare workerssuch as emergency medical technicians (EMTs).

Various CPR feedback devices are available that indicate to a rescuerwhether they are performing CPR chest compressions at an appropriaterate and an appropriate depth of compression, such as dictated byAmerican Heart Association (AHA) guidelines. For example, the PocketCPRapplication for iPhones and iPods may be used for practicing CPR, suchas on a dummy or foam block, and may indicate whether a recent series ofcompressions was performed at the proper rate and proper depth.Similarly, the ZOLL Medical CPR D-Padz are defibrillation pads thatconnect to a defibrillator and include an accelerometer that can be usedto compute the depth and rate of chest compressions on the victim sothat the defibrillator can indicate via recorded voice prompts that arescuer should be instructed, for example, to “press harder” if the unitdetermines that the depth of compression is too shallow.

Professional responders such as EMTs may also receive after-the-factfeedback via processes sometimes referred to as code reviews. Inparticular, data from a patient monitor (which may be incorporated intoa defibrillator) may be saved and may then be loaded into a computerwhere the responder and a supervisor may review the data and then maydiscuss where the responder made errors or performed well, and what theresponder can do to improve his or her performance. Sometimes these codereviews may occur well after the event, after the responder has largelyforgotten the key aspects of the event.

SUMMARY

This document describes systems and techniques that may be used togather information regarding the performance of CPR and other lifesavingtechniques on a patient, and may provide one or more reports at a numberof different locations for such performance. For example, data may begathered for direct primary measurements of aspects of CPR, such asdepth and frequency of compressions. That data may be reportedimmediately on a patient monitor while the rescuer is performing CPR.Additionally, derivative indicators of rescuer performance may also bedetermined for secondary indications of the performance of the CPR thatare derived from two or more of the primary indicators. Such secondaryindications may also be displayed to the rescuer while he or she isperforming the CPR. In addition, while certain measurements may bereported for actions within a sub-set of a CPR cycle or interval, othermeasurements may be reported for a period across an entire interval, sothat a rescuer can compare his or her current performance to performancefor prior CPR intervals—where a CPR interval is the period for acomplete cycle of monitoring, defibrillating, and providing a series ofchest compressions to a patient, such as defined by the 2010 AHA CPRGuidelines.

Such information, and in particular the secondary derived information,may be used to generate a form of report card for the rescuer, wheredata for the report card may be displayed in real-time on a patientmonitor along with the raw data (e.g., for rate and depth ofcompressions) used to generate the report card. As a result, the rescuermay receive greater motivation to improve his or her performance, giventhat he or she is being shown parameters on which his or her performancewill ultimately be reviewed. The primary and secondary measurements mayalso be stored on the monitor and transferred off-site for furtheranalysis. For example, other caregivers may receive the measurement dataat substantially the same time it is being displayed to the rescuer. Asone example, a team at an emergency room where the patient is to betaken may see the data either to provide direction to the rescuer or toidentify opportunities to treat the victim while waiting for the victimto arrive at the emergency room.

Also, the primary and secondary measurements may be stored at a centralsystem for later analysis and in-depth code reviews. For example, aparticular rescuer may log into a patient monitor such as by typing auser name and password or by providing biometric identification (e.g.,taking a digital picture of themselves or swiping a fingertip on anelectronic fingerprint reader), and measurement data may subsequently becorrelated to an identifier for the rescuer. When the data is providedto a central system, it may then be retrieved in combination withmeasurement data for other incidents with that rescuer by using therescuer's identifier. Aggregate data across multiple rescue incidentsmay then be generated for a comprehensive code review, such as bydetermining the rescuer's perfusion level over multiple patients, sothat the rescuer can determine that he or she needs to provide morecomplete perfusion, or to alter his or her performance in other helpfulmanners.

Such data may also be processed by a healthcare billing system so as toprovide a check on a billing event submitted for a rescue event. Inparticular, the information may be used to verify a claim for paymentmade against the victim and by a caregiver organization. The content ofthe information may be reviewed to determine whether care was provided,and what care was provided, and may be checked against a formal claimfor payment by the caregiver organization.

More general review of the data may also be performed across a largerrescuer population (i.e., across data for multiple different rescuers).For example, code reviews may be performed across rescuers in a singleidentified group—such as all rescuers who were trained in a particularclass or program or all rescuers who are based out of a particularfacility—to determine whether a particular endemic problem ismanifesting itself in their rescue performance, and thus whetherremedial action may be required with respect to each of the members inthe group. Also, secondary data may be generated by a central systemfrom the stored primary data, and may be compared to the secondary datathat was generated by the patient monitors for particular incidents. Forexample, a company may identify new ways to measure a rescuer'sperformance and may test those new techniques against the manner inwhich the performance has been determined by monitors in the past, inorder to determine whether the new techniques are an improvement overthe old.

In certain implementations, the systems and techniques discussed heremay provide one or more advantages. For example, by providing a rescuerwith a real-time grade in the form of secondary, derived performancemeasurements that coincide with general measurements on which therescuer will be evaluated, a system may provide greater motivation forthe rescuer to improve his or her performance in real-time. Also, byshowing primary real-time data next to data for prior CPR cycles, arescuer can quickly determine whether current out-of-band performance isa temporary problem or has been a problem throughout a rescue incident.In addition, the rescuer can compensate for problems made in prior CPRcycles. The provision of such data to off-site locations can havefurther advantages, such as by allowing third parties (e.g., emergencyroom teams or post hoc evaluators) to have a better picture of the carethat was provided to a victim. In addition, broader analysis of rescuerdata may be performed, such as by researchers who may use the data toimprove general procedures and guidelines for rescuers.

In one implementation, a computer-implemented method for providingsummary information for lifesaving activities is described. The methodcomprises sensing one or more activities that are repeatedly andcyclically performed on a victim by a rescuer; identifying a cyclicaltiming interval over which performance is to be analyzed for a integernumber of cycles of the one or more activities, and gathering data fromthe sensing of the one or more activities during the time interval;generating, from analysis of the one or more activities, summary datathat condenses data sensed for the one or more activities into a summaryof the one or more activities; and providing, for display to a user, avisual summary of the performance of the one or more activities over theidentified time interval. The sensors can comprise one or more sensorsselected from a group consisting of chest compression sensors, patientventilation sensors, and electrocardiogram sensors. Also, providing thevisual summary for display can comprise wirelessly transmitting dataabout the one or more activities from a device that senses the one ormore activities to a remote device having a visual display devicedisplay. In addition, the remote device can be located in a rescuevehicle proximate to the device that senses the one or more activities.Furthermore, the device that senses the one or more activities can bewirelessly connected to the sensors, and the remote device can belocated in a central medical facility that is distant from the devicethat senses the one or more activities, and data for generating thevisual summary can be provided by transmission through a public datanetwork.

In certain aspects, the summary comprises a score that indicates by oneor more alpha-numeric indicators, a quality level with which the one ormore activities were performed. In addition, the visual summary can beprovided for display on multiple devices simultaneously. The method canalso include monitoring electrocardiogram data of the victim while theone or more activities are occurring, and providing with a defibrillatorat least one of charging the defibrillator and shocking the victimwithout manual intervention of a rescuer. In addition, generatingsummary data can comprise generating a single data value frominformation received from measurement of two or more distinct actionsperformed on the victim.

In another implementation, a system for providing summary informationfor lifesaving activities is disclosed that comprises a patient monitorhaving an interface for receiving signals from one or morepatient-connected sensors; a rescuer performance analysis systemprogrammed using stored instructions to incorporate data representativeof a plurality of activities performed on a patient by a rescuer in theform of primary indications, and to generate secondary indications ofthe performance of cardiopulmonary resuscitation on the patient from thedata; and one or more user interfaces to provide audible or visualindications of the generated secondary indications.

In yet another implementation, a computer-implemented system forproviding summary information for lifesaving activities is disclosed.The system comprises a patient monitor having an interface for receivingsignals from one or more patient-connected sensors; means for generatingprimary and secondary indications of cardiopulmonary resuscitation on apatent, the primary indications being direct representations of datameasured from the patent, and the secondary indications being derivedrepresentations generated from one or more of the primaryrepresentations; and one or more user interfaces to provide audible orvisual indications of the generated secondary indications.

The details of one or more embodiments are set forth in the accompanyingdrawings and the description below. Other features and advantages willbe apparent from the description and drawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1A shows a system for responding to an emergency medical condition.

FIG. 1B is a flow diagram of a CPR data acquisition process.

FIGS. 2A and 2B are screen shots of a tablet device showing a summary ofrescuer performance in a CPR setting.

FIG. 3 is a flow chart of a process for capturing user performance dataduring the provision of CPR.

FIG. 4 is a swim lane diagram of a process for sharing CPR performancedata between various sub-systems in a larger healthcare system.

FIG. 5 shows an example of a generic computer device and a genericmobile computer device, which may be used with the techniques describedhere.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

This detailed description discusses examples of implementations that maybe employed in capturing data from a rescuer performing CPR and otherrelated activities on a patient or victim (the terms are usedinterchangeably here to indicate a person who is the subject of intendedor actual CPR and related treatment, or other medical treatment). Thedata may include both primary data that directly measures a parameter ofan action performed on the patient, as well as secondary data that isderived from multiple pieces of the primary data. Also, the data mayinclude real-time data for portions of a current CPR interval, and pastdata for prior CPR intervals. For example, a device may show the depthand rate of compression for the last compression (e.g., for depth) orlast few chest compressions (e.g., for rate) performed by a rescuer.Adjacent that representation, the device may show the average rate anddepth of compressions performed for each of the prior several CPRintervals. In such a manner, the rescuer can quickly see how they aredoing and can adjust their performance accordingly, and then receiveimmediate feedback on whether their adjustments have been effective.

FIG. 1 shows a system 100 for responding to an emergency medicalcondition of a victim 102. In general, system 100 includes variousportable devices for monitoring on-site care given to a victim of anemergency situation, such as a victim 102 suffering from sudden cardiacarrest or a victim 102 at the scene of a traffic accident. The variousdevices may be provided by emergency medical technicians who arrive atthe scene and who provide care for the victim 102, such as emergencymedical technician 114. In this example, the emergency medicaltechnician 114 has deployed several devices and is providing care to thevictim 102. Although not shown, one or more other emergency medicaltechnicians may be assisting and working in coordination with emergencymedical technician 114 according to a defined protocol and training.

The emergency medical technician 114 in this example is interacting witha computing device in the form of a touchscreen tablet 116. The tablet116 may include a graphical display by which to report information tothe emergency medical technician 114, and may have an input mechanismsuch as a keyboard or a touchscreen by which the emergency medicaltechnician 114 may enter data into the system 100. The tablet 116 mayalso include a wireless transceiver for communicating with a wirelessnetwork, such as a 3G or 4G chipset that permits long distancecommunication over cellular data networks, and further through theinternet.

Separately, a portable defibrillator 112 is shown in a deployed stateand is connected to the victim 102. In addition to providingdefibrillation, the defibrillator 112 may serve as a patient monitor viaa variety of sensors or sensor packages. For example, as shown here,electrodes 108 have been applied to the bare chest of the victim 102 andhave been connected to the defibrillator 112, so that electricalshocking pulses may be provided to the electrodes in an effort todefibrillate the victim 102, and electrocardiogram (ECG) signals may beread from the victim 102. The defibrillator 112 may take a variety offorms, such as the ZOLL MEDICAL R Series, E Series, or M Seriesdefibrillators.

The assembly for the electrodes 108 includes a center portion at whichan accelerometer assembly 110 is mounted. The accelerometer assembly 110may include a housing inside which is mounted an accelerometer sensorconfiguration. The accelerometer assembly 110 may be positioned in alocation where a rescuer is to place the palms of their hands whenperforming cardio pulmonary resuscitation (CPR) chest compressions onthe victim 102. As a result, the accelerometer assembly 110 may movewith the victim's 102 chest and the rescuer's hands, and acceleration ofsuch movement may be double-integrated to identify a verticaldisplacement of such motion (i.e., to compute the displacement of thevictim's breastbone for comparison to American Heart Association (AHA)guidelines).

The defibrillator 112 may, in response to receiving such informationfrom the accelerometer assembly 112, provide feedback in a conventionaland known manner to a rescuer, such as emergency medical technician 114.For example, the defibrillator 112 may generate a metronome to pace sucha user in providing chest compressions. In addition, or alternatively,the defibrillator 112 may provide verbal instructions to the rescuer,such as by telling the rescuer that they are providing compressions tooquickly or too slowly, or are pushing too hard or too soft, so as toencourage the rescuer to change their technique to bring it more in linewith proper protocol—where the proper protocol may be a protocolgenerated by the system, but that is inconsistent with any publishedprotocols. In addition, similar feedback may be provided visually on ascreen of the defibrillator, such as by showing a bar graph or numberthat indicates depth and another that indicates rate, with appropriatemechanisms to indicate whether the depth and rate or adequate, too low,or too high.

The defibrillator 112 may communicate through a short range wirelessdata connection with the tablet 116, such as using BLUETOOTH technology.The defibrillator 112 can provide to the tablet 116 status information,such as information received through the electrode assembly 108,including ECG information for the victim 102. Also, the defibrillator112 can send information about the performance of chest compressions,such as depth and rate information for the chest compressions. Thetablet 116 may display such information (and also other information,such as information from the defibrillator regarding ETCO2 and SPO2)graphically for the emergency medical technician 114, and may alsoreceive inputs from the emergency medical technician 114 to control theoperation of the various mechanisms at an emergency site. For example,the emergency medical technician 114 may use the tablet 116 to changethe manner in which the defibrillator 112 operates, such as by changinga charging voltage for the defibrillator 112.

Where described below, the processing and display of data may occur onthe defibrillator 112, the tablet 116, or on both. For example, thedefibrillator 112 may include a display that matches that of the tablet116, and the two may thus show matching data. In contrast, thedefibrillator 112 may have a more limited display than does the tablet116, and might show only basic information about the technician'sperformance, while the tablet 116 may show more complete informationsuch as secondary historic information. Also, the processing of primaryinformation to obtain secondary information may be performed by thedefibrillator 112, the tablet 116, or a combination of the two, and thetwo devices may communicate back and forth in various manners to provideto each other information they have received or processed, or to relaycommands provided to them by the technician 114.

Another electronic mechanism, in the form of a ventilation bag 104, isshown sealed around the mouth of the victim 102. The ventilation bag 104may, for the most part, take a familiar form, and may include a flexiblebody structure that a rescuer may squeeze periodically to provideventilation on the victim 102 when the victim 102 is not breathingsufficiently on his or her own.

Provided with the ventilation bag 104 is an airflow sensor 106. Theairflow sensor 106 is located in a neck of the ventilation bag 104 nearthe mouthpiece or mask of the ventilation bag 104. The airflow sensor106 may be configured to monitor the flow of air into and out of thepatient's mouth, so as to identify a rate at which ventilation isoccurring with the victim. In addition, in certain implementations, theairflow sensor 106 may be arranged to monitor a volume of airflow intoand out of the victim 102.

In this example, the airflow sensor 106 is joined to a short-rangewireless data transmitter or transceiver, such as a mechanismcommunicating via BLUETOOTH technology. As such, the airflow sensor 106may communicate with the tablet 116 in a manner similar to thecommunication of the defibrillator 112 with the tablet 116. For example,the airflow sensor 106 may report information that enables thecomputation of a rate of ventilation, and in some circumstances a volumeof ventilation, that is being provided to the patient. The tablet 116,for example, may determine an appropriate provision of ventilation andcompare it to the level of ventilation that the victim is receiving, andmay provide feedback for a rescuer, either directly such as by showingthe feedback on a screen of the tablet 116 or playing the feedbackthrough an audio system of the tablet 116, or indirectly, by causingdefibrillator 112 or airflow sensor 106 to provide such feedback. Forexample, defibrillator 112 or airflow sensor 106 may provide a metronomeor verbal feedback telling a rescuer to squeeze the ventilation bag 104harder or softer, or faster or slower. Also, the system 100 may providethe rescuer was an audible cue each time that the bag is to be squeezedand ventilation is to be provided to the victim 102.

Such feedback may occur in a variety of manners. For example, thefeedback may be played on built-in loudspeakers mounted in any of tablet116, defibrillator 112, or airflow sensor 106. Alternatively, or inaddition, visual notifications may be provided on any combination ofsuch units. Also, feedback may be provided to wireless headsets (orother form of personal device, such as a smartphone or similar devicethat each rescuer may use to obtain information and to enter data, andwhich may communicate wirelessly over a general network (e.g., WiFi or3G/4G) or a small area network (e.g., BLUETOOTH) that are worn by eachrescuer, and two channels of communication may be maintained, so thateach rescuer receives instructions specific to their role, where one mayhave a role of operating the defibrillator 112, and the other may havethe role of operating the ventilation bag 104. In this manner, the tworescuers may avoid being accidentally prompted, distracted, or confusedby instructions that are not relevant to them.

A central server system 120 may communicate with the tablet 116 or otherdevices at the rescue scene over a wireless network and a network 118,which may include portions of the Internet (where data may beappropriately encrypted to protect privacy). The central server system120 may be part of a larger system for a healthcare organization inwhich medical records are kept for various patients in the system.Information about the victim 102 may then be associated with anidentification number or other identifier, and stored by the centralserver system 120 for later access. Where an identity of the victim 102can be determined, the information may be stored with a pre-existingelectronic medical record (EMR) for that victim 102. When the identityof the victim 102 cannot be determined, the information may be storedwith a temporary identification number or identifier, which may be tiedin the system to the particular rescue crew so that it may beconveniently located by other users of the system.

Information that is stored for a rescue incident may also include anidentifier for the technician 114 and any other technician thatparticipated in the rescue. Using such identifiers, the server system120 may later be queried so as to deliver data for all incidents thatthe particular technicians have been involved in. The tablet 116 ordefibrillator 114 may include mechanisms so that the technicians canidentify themselves and thus have their identifier stored with theinformation. For example, the technicians may be required to log in withthe tablet 116 when their shift starts, so that all informationsubsequently obtained by the tablet 116 or components in communicationwith the tablet may be correlated to the identifier. Such logging in mayrequire the entry of a user name and password, or may involve biometricidentification, such as by the pressing or swiping of a technician'sfingertip on a fingerprint reader that is built into the tablet 116.

The information that is stored may be relevant information needed todetermine the current status of the victim 102 and the care that hasbeen provided to the victim 102 up to a certain point in time. Forexample, vital signs of the victim 102 may be constantly updated at thecentral server system 120 as additional information is received from thetablet 116 (e.g., via the defibrillator 114). Also, ECG data for thevictim 102 may be uploaded to the central server system 120. Moreover,information about drugs provided to the victim may be stored. Inaddition, information from a dispatch center may also be stored on thecentral server system 120 and accessed by various users such asrescuers. For example, a time at which a call came in may be stored, andrescuers (either manually or automatically through their portablecomputing devices) can use that time to determine a protocol fortreating the patient (e.g., ventilation or chest compression needs maychange depending on how long the victim has been in need of treatment).

Other users may then access the data in the central server system 120.For example, as shown here, an emergency room physician 122 is operatinghis or her own tablet 124 that communicates wirelessly, such as over acellular data network. The physician 122 may have been notified thatvictim 102 will be arriving at the emergency room, and, in preparation,may be getting up-to-speed regarding the condition of the victim 102,and determining a best course of action to take as soon as the victim102 arrives at the emergency room. As such, the physician 122 may reviewthe data from central server system 120. In addition, the physician 122may communicate by text, verbally, or in other manners with emergencymedical technician 114. In doing so, the physician 122 may ask questionsof the emergency medical technician 114 so that the physician 122 isbetter prepared when the victim 102 arrives at the emergency room. Thephysician 122 may also provide input to the emergency medical technician114, such as by describing care that the emergency medical technician114 should provide to the victim 102, such as in an ambulance on the wayto the emergency room, so that emergency room personnel do not have tospend time performing such actions. Also, physicians could see aspectsof a currently-operating protocol on the system (e.g., an AHA CPRprotocol), and could act to override the protocol, with or without therescuers needing to know that such a change in the protocol has beenmade (e.g., their devices will just start instructing them according tothe parameters for the manually-revised protocol).

Where the published protocol is organized in a flowchart form, theflowchart may be displayed to a rescuer or a physician, and such usermay drag portions of the flowchart to reorder the protocol.Alternatively, the user could tap a block in the flowchart in order tohave parameters for that block displayed, so that the user can changesuch parameters (e.g., ventilation volume or time between ventilations).Data describing such an edited protocol may then be saved with otherinformation about an incident so that later users may review it, and auser may save reordered protocols so that they can be employed moreeasily and quickly in the future.

In this manner, the system 100 permits various portable electronicdevices to communicate with each other so as to coordinate care that isprovided to a victim 102. In addition, the system 100 allows thetechnician 114 and others to see raw real-time data and derivedreal-time or historical data about a rescue attempt. Such data may bearranged so that a technician can immediately see whether his or herperformance is matching or has matched agreed-upon standard, and canquickly adjust his or her performance while the incident is still goingon. In addition, such information may be aggregated across multipleincidents for a particular rescuer, and across multiple incidents formultiple rescuers so as to be able to provide more broad-based reportcards for performance, and to permit more general modification of futureperformance (e.g., for a rescuer who regularly under-perfuses victims).

Each device in the system 100 may sense information about the careprovided to the victim 102, and/or may provide instructions or may storedata about such care. As a result, the system 100 may provide improvedcare for the victim 102 by better integrating and coordinating each formof the care that the victim 102 receives. The victim 102 made thusreceive improved care and an improved chance of obtaining a positiveoutcome from an event.

In certain instances, a condition of a victim that is used to generate aprotocol for treatment of the victim may be based on on-siteobservations made by a rescuer, by information in an EMR for the victim,or both. For example, a determination from an EMR that a victim istaking a particular drug may result in a change in protocol forventilation rate. Likewise, an observation by a rescuer that the victimhas suffered a head injury on site may also affect the protocol forventilation rate. The two factors may also be considered together todetermine yet a more refined ventilation rate for which a rescuer willbe instructed to provide to the victim. Also, the real-time feedbackthat is provided to a technician 114 may be automatically altered inresponse to identifying such special cases in an EMR or in informationentered by the technician 114 (e.g., after a conscious victim hasprovided the information to the technician 114).

Thus, in operation, a two-person rescue team may arrive at a scene. Onemember of the team may set up and attach a defibrillator/monitor to avictim, and do the same with a ventilation bag assembly. The othermember may begin an examination of the victim and may enter informationobtained from the examination into a portable computing device such as ageneral tablet computer (e.g., an iPad or netbook). In some situations,the second rescuer may be able to verbally interview the victim, atleast initially, so as to determine whether the victim is lucid, whatdrugs the victim may be taking, and the like. The second rescuer couldalso make visual observations (e.g., types of trauma to the victim) andrecord those in the computing device. Moreover, one of the rescuers mayobtain vital sign information for the victim, and such information maybe entered manually into the computing device or automatically, such asthrough wireless links from a blood pressure cuff, or other relevantmedical device.

The computing device, using all of the entered information, may thengenerate a protocol for treating the victim. Such a generating may occurby selecting from among a plurality of available protocols by pluggingthe observations into a protocol selector. The generation may also bemore dynamic, and may depends on a series of heuristics that use theobservations as inputs, and generate a protocol (which may be made up ofone or more sub-protocols) as an output. Moreover, a lookup table may beconsulted, where the table may define correlations between particularobserved patient conditions or physical parameters, and a particularfeature of a treatment protocol.

The computing device may also submit the observation information over anetwork such as the internet, and a protocol may be generated by acentral computer server system and then automatically downloaded to, andimplemented by, the portable computing device. Such an approach may havethe benefit of being able to easily update and modifyprotocol-generation rules.

The computing device may then receive information about the performanceby the rescuers, such as from wired or wireless transmitters on adefibrillator, an assisted ventilation unit, or other medical device(e.g., blood pressure reader). The computing device may provide feedbackor coaching when the performance falls out of line with a definedprotocol, or may provide feedback to maintain the performance in linewith the protocol. In providing the feedback, the computing device orthe defibrillator/monitor may generate a number of derived parametersfrom measure parameters of the victim, and both the measured parametersand the more comprehensive derived parameters may be reported visuallyor audibly by the computing device, the defibrillator/monitor, or both.Also, the computing device may update the protocol as care is beingprovided to the victim. For example, the rate of required ventilation orchest compressions may change as a function of time. Also, if one of therescuers attaches an oxygen source to a ventilation assembly (as sensed,e.g., by a switch where the connection occurs, by a manual rescuer inputto the system, or by sensors in the assisted ventilation system), therate of required ventilation may change. Other changes in the patientcondition, such as changes in measured levels of ETCO2 or SpO2, can leadto the computing device generating a revised protocol and providingfeedback to the rescuers so that they adapt to the revised protocol(sometimes without consciously knowing that the protocol has beenrevised).

FIG. 1B is a flow diagram of a CPR data acquisition process. In general,the data acquisition occurs in parallel with performance of CPRaccording to the 2010 American Heart Association Guidelines forCardiopulmonary Resuscitation and Emergency Cardiovascular Care. Dataacquisition in this example occurs in real-time throughout the provisionof CPR to a victim, and such real-time data may be continuously updatedand displayed to rescuers or others. Also, certain secondary informationmay be generated from the real-time information, either periodicallysuch as at the end of each CPR interval in the cycles, or at the end ofa rescue incident (where an incident is an entire attempt to rescue avictim, from the beginning of data collection to the time a patientmonitor is removed from a patient, the patient leaves the scene of theincident, or another rescuer or group of rescuers takes over).

According to the CPR guidelines, the process begins at box 140, where arescuer endeavors to evaluate a victim. Such evaluation may occur byfamiliar mechanisms, such as by determining whether the victim isbreathing, responsive, or has a pulse. If a problem with the victim isdetermined, the rescuer begins an emergency response at box 142. Forexample, the rescuer may cause an emergency response team to be calledto the scene and may get a defibrillator 144 or cause another person toget a defibrillator if the victim appears to suffer from sudden cardiacarrest or a similar problem.

Having performed such actions, the rescuer may begin performing cardiopulmonary resuscitation (CPR) on the victim at box 146. According toprotocol, CPR involves a cyclical process that is repeated every twominutes, as indicated by the circular arrow in the figure. At thebeginning of each cycle, a defibrillator that has had leads attached tothe victim may analyze the victim, such as by analyzing an ECG readingfor the victim or other information to determine whether the victim hasa shockable rhythm. Techniques for performing such analysis arewell-known and the particular technique that is used here is notcritical. If a shockable rhythm is determined to be present, a shock maybe delivered as shown by box 148. For example, the defibrillator mayprovide a display to a rescuer or may speak words to the rescuerindicating that a shock should be delivered. The rescuer may then pressa button on the defibrillator to cause a shock to be delivered, afterall people around the victim have moved away from the victim.

The rescuer may then perform chest compressions on the victim for theremainder of the cycle or interval. After a predetermined time period ofproviding chest compressions, or during the chest compressions, thedefibrillator may again analyze the victim's condition to determinewhether they have a shockable rhythm. For example, the defibrillator mayinclude componentry for filtering out CPR artifacts from chestcompressions as compared to an ECG signal, and may perform the analysison the filtered signal.

Box 150 is shown along the loop of the CPR cycle to indicate a currenttime in the cycle. In particular, the box 150 indicates that thedefibrillator or another device may, at the current point in time, becomputing and displaying certain parameters regarding the care that isbeing provided to the victim. Certain of those parameters may be initialor primary parameters in that they are direct representations of valuesread from the patient. Such parameters may include depth and rate ofchest compressions provided to the victim. Other of the reportedparameters may be secondary parameters in that they are derived from theinitial parameters, either from one or a multiple of different initialparameters. For example, certain values may be computed from acombination of the compression rate and the compression depth. Also moregeneral composite values may be generated, such as a letter or numbergrade that indicates how the rescuer is currently performing.

Box 152 represents values that are generated periodically, such as witheach cycle of a CPR interval in a particular location in the interval,or at the end of an incident. The values that are generated may include,for example, average values for particular primary parameters over aperiod of an interval. For example, the average rate and depth over aninterval may be computed at the end of each interval and may be saved ina database such as in a manner shown by box 152. Also, the savedparameters may include derived or secondary parameters that are computedfrom initial parameters, such as from average values of initialparameters, or by combining multiple initial parameters from throughoutan interval, and then averaging the combination. In this example, aprofusion percentage is given as one example of a secondary or derivedparameter, and letter grades for each interval are also secondary orderived parameters.

In this manner, a performance reporting approach may be implemented incoordination with standard CPR techniques so as to capture and reportinformation that is particularly relevant to a rescuer or to a partyafter the fact of a rescue. The information may include basicmeasurements from the performance of CPR on a patient, and may alsoinclude derived values that may provide a model or compelling orunderstandable representation of the rescuers performance. For example,the parameter that is displayed to the rescuer may be similar to or thesame as a parameter on which the rescuers performance will be judged bya later review work of an incident as part of the code review. Therescuer may thus be more responsive to such a displayed parameter if therescuer is performing poorly, than the rescuer would be in response tosimple values of depth and rate of compressions. As a result, therescuer may be more likely to change his or her behavior in a positivemanner so as to improve the care that is provided to a patient orvictim.

The monitoring and feedback provided by such a process may also beaffected by basic configuration data obtained by the system. Forexample, before monitoring by the system begins, a process may havegathered certain data to aid in the monitoring. For example, as arescuer sets up a defibrillator and hooks it to a victim, thedefibrillator may ask the rescuer (on a display or via a spoken request)whether the rescuer is alone or is being aided, and might also ask howmany additional rescuers are available. If the rescuer indicates that heor she is alone, then the system may follow a branch of programming thatdoes not recommend switching of rescuers, but might more aggressivelyprovide feedback in order to overcome the extra fatigue a solo rescuerwill face. If the rescuer is accompanied, then the system maysubsequently indicate when rescuers are to switch roles. The system mayalso assign a label to each rescuer, such as “Rescuer 1” and “Rescuer 2”or the actual names of the rescuers (which could have been programmedpreviously, such as for EMTs who use the system frequently, or could beobtained, such as by lay rescuers speaking their names into the devicein response to prompts from the device). If there are three or morerescuers, instructions for rotating may be more complex—i.e., involvingmore than simply an instruction to switch positions, but instead tellingeach rescuer what component of CPR they should be performing for anyparticular time period.

A determination about the number of rescuers may also be madeinferentially. For example, a ventilation bag may include electronicsthat report to a defibrillator or other box, and the box may sense thatthe bag is being deployed or used, or is being used simultaneous withchest compressions being performed, in order to infer that there are atleast two rescuers. The defibrillator may adjust its operationaccordingly in the manners discussed above in such a situation (e.g. byenabling prompts for rescuers to switch roles).

As for operation of the system during performance of CPR, in certaincircumstances, prompts for performing CPR may change the way in whichCPR is to be performed in response to indications that there has been adegradation in performance. For example, a protocol by which a user isinstructed may change based on such an observation that performance hasdegraded, so as hit a performance level that the user can bettermaintain, even if that level is sub-optimal. In particular, prompting ofCPR at a sub-optimal level may be provided, as long as that sub-optimallevel is better than wholly fatiguing a rescuer.

For example, hemodynamics data has indicated that depth of chestcompressions may be more important to victim well-being than is rate ofcompressions—i.e., it may essentially not matter how fast you areperforming compressions if none of those compressions is trulyeffective. As a result, a system may slow a rate (e.g., a metronome) ofprompting compressions and may monitor how the depth of compressionschanges in response to the prompted change in rate. Using storedhemodynamic data correlating depths and rates to effectiveness, thesystem may identify a most-preferred rate that maximizes the hemodynamiceffect for a particular rescuer (using, e.g., the well-known Windkesselmodel or other approach). While such modifications may be made onlyafter sensing that a particular rescuer is fatiguing, they can also beinitiated at other points and in response to other criteria, includingby making such adjustments throughout a rescue cycle (e.g., the rate ofa metronome may be adjusted slightly and essentially continuously, andthe combination of depth and rate that is measured from the rescuer maybe input in real-time to a formula for computing hemodynamic effect,with subsequent changes in the rate of the metronome being made in anattempt to increase the hemodynamic effect within bounds of safety).

Also, physical data of the rescuer or rescuers may also be monitoredwhile care is being provided to a victim, such as to determine whetherthe rescuers are tiring and should be prompted in a different manner, orshould be instructed to switch out to other rescuers as they fatigue.For example, a rescuer may be outfitted with a pulse oximeter such asone that can be attached to a CPR puck on a victim's chest and intowhich the rescuer can place one or more fingers. The readings of therescuer's blood oxygen level and pulse rate may be used to determinethat the rescuer is fatiguing and will not be able to continueperformance at a current level for very long. As a result, a medicaldevice can cause the rescuer to switch places with another rescuer, mayprovide encouragement to the rescuer, or may reduce the rate or severitywith which the rescuer is providing care so as to maximize the work therescuer can do, even if it is below what would otherwise be consideredan optimum level of care.

Thus, these techniques may be used to identify rescuer performance,including indications of fatigue while providing such performance, forreview by the rescuers or other at various points in time. For example,a medical device may immediately monitor the performance to providefeedback or adjust the manner in which it provides feedback so as tomaintain a best level of performance over the length of a rescueoperation, including by instructing rescuers to switch places atappropriate times so as to lessen the effect of fatigue. The rescuersthemselves may also be provided with information as described above andbelow so that they may adjust their performance of care on a victim inreal-time as they perform the care. Also, care may be reviewed after thefact, such as by rescuers to determine how they can perform better as ateam or perhaps to determine that they should increase their physicalconditioning to combat fatigue, and also by supervisors.

FIG. 2A is a screen shot of a tablet device showing a summary of rescuerperformance in a CPR setting. In general, the screen shot shows roughlythe sort of parameters that may be displayed on a tablet computer asfeedback for a rescuer at the scene of an accident, or to a physicianwho is following the performance of care on a victim remotely.

The presentation of information in this example is split into twoportions—a top portion that shows averaged performance over an entireincident, and a bottom portion that shows the performance average overeach of the last three CPR intervals, with display of current depth andrate displayed immediately under the second portion.

Referring now to particular portions of the display, a rescuer is shownthat their average depth of compression in performing CPR has been 1.8inches for an incident, and that the appropriate range for compressionis 1.5 inches to 3.0 inches. Similarly, the rescuer is shown that theiraverage rate of compressions is 118 compressions per minute (CPM), whichis within the approved range of 100 to 120 CPM. The approved range forcompression fraction is over 75%, but the average for this rescuer is73%. The fact that the rescuer is outside of the approved range isindicated here by a dashed box around the average value, to drawattention of the rescuer to the fact that improvement is needed in thisvalue. Similarly, values are displayed for the rescuer's delay inpre-shock and post-shock activity and for a profusion index by therescuer. The particular values shown here were selected merely todemonstrate how values may be displayed to a rescuer, such as on adefibrillator/monitor, tablet computer, or similar device, and are notmeant to represent actual values that would necessarily be displayed inan actual situation.

In the minute-by-minute CPR area of the display, three lines of valuesare shown, where the values are average values for each of the lastthree CPR intervals performed on the victim, so they representapproximately the last six minutes of CPR performed on the victim,though perhaps not the entirety of CPR that has been performed on thevictim. Again, individual values are provided for each of the intervals,and values that are outside of range are highlighted by a dashed box,though as discussed below, other mechanisms for drawing attention toout-of-range or in-range values may be employed.

Also, two of the values—for depth and rate of compression—are shownaccording to their current states. Specifically, the last compressionperformed by the rescuer had 3.2 inches of travel, and the last severalcompressions were performed at a rate of 110 CPM. Solid boxes are shownaround these values to draw particular attention to them for therescuer, so that the rescuer can quickly see what his or her immediatelycurrent performance has been.

Additional guidance may be provided to a viewer of the display, such asto a rescuer, by using color, animation, and sound feedback. Forexample, any values on the display that are outside a desired range maybe displayed in red, while values at the edge of the range may bedisplayed in yellow, and values inside the range may be displayed ingreen color. Also, particularly important values may be highlighted bymaking them blink, wiggle, or shimmer, so as to call a viewer'sattention particularly to them. Also, the device may beep or speakrecorded instructions when the rescuer needs guidance in returning toapproved performance ranges.

The particular arrangement of values on the display here is providedmerely as an example of data that may be shown to a rescuer or to aphysician while care is being provided to a victim. Other arrangementsof information may also be employed. In particular, less informationthan is shown here may be provided, and may be shown in a smallerportion of the screen, thus leaving room for the display of otherinformation that may be pertinent to a rescuer. One such example isshown in FIG. 2B.

In particular, FIG. 2B shows another screen from a device such as apatient monitor or tablet computer that may be displayed to a rescuer.In this example, a performance area 238 (i.e., an area that rates andreports on the rescuer's performance) takes up a relatively small partof the entire display. The data that is displayed is similar to thatdisplayed in FIG. 2A., but only average values across the entireincident, and immediate values for depth and rate, are displayed. Anumerical or alphabetical grade (not shown) may also be provided nearthis area as a higher level, more summarized, view of the performance.

The relatively small size of the performance area 238 leaves additionalroom on the display to show other data about a rescue incident. Forexample, a victim identification area in the upper left corner of thedisplay includes an image 232 of the victim and personal information 234about the victim. The image 232 may be obtained from a central serversystem in response to entering identification information for thevictim. For example, a driver's license found with the victim mayindicate a name of the victim, or a fingerprint may be obtained from afingerprint reader for the victim, where the fingerprint reader may beincorporated with a blood oxygenation sensor. Such a mechanism foridentifying the victim may be used to recover limited medical recordinformation about the victim, such as the blood type, allergies andmedications taken by the victim. The image 232 may be displayed so thatthe rescuer may manually confirm that the patient who is identified bythe system is the same person as the victim who is lying front of them(where the victim is unable to identify himself or herself).

An ECG display 236 is also provided in a familiar manner in an area thedisplay 236, showing an ECG trace and may also display warnings or otherdata such as an indication of the amount to which capacitors on adefibrillator have been charged, and whether they are ready fordischarge. Other information that is not shown here may also be providedon the display. For example, countdown timers may be shown to indicatefuture activities that will need to be performed by the rescue team. Asone example, a countdown timer may indicate the amount of time left in aCPR interval. Also a countdown timer may indicate time for a anotherrescuer, such as time for providing ventilation to the patient orvictim, or time until a particular drug is to be provided by therescuers to the victim.

The display may also show content that is typed by a physician at anemergency room, or other similar content. For example, the physician maymonitor information like that shown in this figure, and may provideguidance to a rescuer by typing it, similar to an online chat system. Inother implementations, a voice connection may be made up with thephysician, and instructions from the physician may be heard through thetablet computer, the defibrillator monitor, a BLUETOOTH headset that isprovided with data from the tablet or monitor, or through another formof communication device employed by the rescuer.

Using displays like those shown in FIGS. 2A and 2B, a system may provideimproved feedback to a rescuer in an emergency situation. The feedbackmay be provided in a graphical manner that indicates information that ismost important to the rescuer, and is thus most likely to be acted uponby a rescuer. Also, the information that is provided may be a form ofcombined information that provides a higher level view of the rescueoperation. For example, a number of different actions or activities thatare performed by a rescuer on a victim may be combined using apredetermined formula or algorithm to produce a more general descriptorof the quality of care that is given to the victim. Such automaticcombination by the system may relieve a rescuer of having to make suchdeterminations themselves. For example, a particular combination ofcompression rate and depth, albeit nominally out of range for eitherrate or depth or both, may be within a desired range when the values forrate and depth are applied against each other, such that out of rangevalues for each variable cancel each other out. Also, where theinformation is more generalized, it may be more in line with the form ofinformation on which the rescuer will be judged in the performance oftheir job, so that a rescuer may be more likely to respond to it.

FIG. 3 is a flow chart of a process for capturing user performance dataduring the provision of CPR. In general, the process involves receivingraw information from sensors that are connected to a patient monitor,which may be incorporated into a defibrillator as described above,generating derivative data, displaying to a user of the monitor valuesfor the raw data and the derivative data, and also displaying values forreal-time measurements and historic measurements. For example, thereal-time raw measurements may include depth and rate of compressionduring CPR that is being performed on a patient who is being monitored.The derived measurements may include a perfusion percentage and overallletter or number grade for the performance of the user. The historicalmeasurements may include measurements for portions of, or all of, priorCPR intervals, or for averages from such periods or across multipleintervals.

The process begins at box 302, where a medical device/monitor, such as adefibrillator with built-in capabilities for monitoring motion of chestcompressions and ECG signals, among other parameters, senses cyclicalactivities that are being performed on a patient. Such cyclicalactivities may include the provision of CPR in a recursive cyclefollowing the 8H a guidelines discussed above, where the cycle involvesanalyzing a patient such as to determine whether the patient exhibits ashock of all heart rhythm, providing a shock if the patient has such arhythm, and providing chest compressions to the heart to cause perfusionof blood in and through the heart. The particular activities maygenerate data from sensors, and the step of sensing the activities mayinclude converting the data to a more usable form, such as by convertinga voltage received from an accelerometer into a computed depth ofcompression for a patient's chest.

At box 304, the process identifies intervals for the cycles in theprovision of care to the victim or patient. Thus, for example, theprocess may identify starting and ending points for each of the CPRintervals and may thereby associate data received between each startpoint and end point with a particular one of the intervals. Suchassociation of received data with particular intervals may enable thepresentation of information about the data to a user in a manner thatthe information is correlated to the particular intervals in which itwas received.

At box 306, data is gathered for sensing activities during theidentified cycles. Such data gathering may be continuous during theperformance of CPR and other activities on a patient or victim, suchthat particular ones of the actions described here may be repeated overand over until a rescuer terminates a monitoring described here. As thedata is gathered, it may receive a first level processing, such asdescribed above to convert voltages into more usable values such asdisplacements or accelerations. Similarly, the monitor may changevoltages from leads that are attached to the patient into values for anECG signal that may be easily graphed on the monitor or on anotherdevice. Such initially-processed data may then be stored on the device,and copies of some or all of the data may be provided to other devices.For example, the data may be transferred over a short range wirelessconnection to a device such as a tablet 116 or server 120 in FIG. 1.Such transfer of data may be in batches or may be continuous orsubstantially continuous. For example, an automatic batch upload of datamay be triggered at particular points during treatment of a patient,such as after a rescuer terminates treatment. A proximity sensor may beused to determine that pretreatment has terminated because the monitorhas returned to a vehicle such as ambulance, and such sensing may beused to trigger the batch transfer of data between the monitor anddevices in the ambulance, and then further to a separate device such asserver 120. In another implementation, the batch transfer may betriggered by a GPS unit in the device sensing that the device is movingabove a particular speed, such as 15 mph, and thus concluding that thedevice has been placed in an ambulance and that its use is complete.Such determination may also be combined with a determination thatpatient conditions are no longer being received from the various sensorsto which the device has been connected. Continuous transfer of data mayoccurred by a variety of mechanisms, such as by caching received andinitially-processed data, and then uploading or otherwise transferringthe data at close-spaced periods.

At box 308, the gathered data is processed to generate summarized data,which is a derivative form of the initially gathered data. For example,information about rate and depth of chest compressions may be used alongwith other information obtained by a system to identify a level ofperfusion for a patient. In addition, summaries may be generated forentire CPR intervals or multiple CPR intervals. As one example,particular values that have been captured and recorded for performanceof activities on a patient may be aggregated, such as by generating anaverage value for a CPR interval or an average value across multiple CPRintervals. Thus, for example, a perfusion level for the entire time thata rescuer has been performing CPR on a patient may be computed and maybe reported back out to the rescuer.

Also, as shown at box 310, summarized data may be consolidated across anumber of activities, such as data relating to chest compressions anddata relating to ventilation that can be combined to identify an overallindicator of care that is been provided to the patient. Thus, in suchexamples, the derivative data may not only be derived from the originaldata, such as depth of compression, but may also be derived from twoseparately obtained pieces of original data. Such combining of datasources across multiple activities being performed on the patient mayalso be used to generate a score or grade for the care provided so farto the patient, so as to indicate manners in which the rescuer canchange subsequent care that is given. For example, monitoring ofparameters like those discussed in FIGS. 2A and 2B may indicate that arescuer is too excited or too relaxed in giving their care (e.g.,because they are compressing the chest too soft or too hard, or they areacting too quickly or too slowly in certain parts of the CPR interval).In such a situation, a score from −5 to +5 may be assigned, where ascore of 0 is perfect, scores farther below 0 indicate that the rescuerneeds to be more active in their care, and scores above 0 indicate thatthe rescuer needs to take a deep breath and relax a bit. Such a scoremay be displayed in a location on a screen of a monitor, tablet computeror similar computing device. The score or grade for the entire sessionmay also be submitted to a supervisor of the rescuer as part of a posthoc code review of the session.

Such presentation of the raw and derived data is represented by box 312,where a visual summary of the user's performance is displayed. Suchdisplay, as discussed above, can be on a monitor, on a tablet, on aseparate computer used by another caregiver, or by other mechanisms. Thedisplay may take a form, for example, similar to that shown in FIGS. 2Aand 2B.

At box 314, summary information for an incident or session is saved.Such a step could take place continuously or semi-continuouslythroughout an incident or may occur as a batch upload once the incidentis over, as discussed above. The information may be saved locally andmay also be saved on a more global server system from which supervisorsor analysts may access both the raw and derived data. Presentations ofthe data similar to those shown above may be provided, and a replay maybe had of the data that would have been displayed to the rescuer. As aresult, the rescuer and an official may step through the sessionstep-by-step, and the official may point out exactly what the rescuerdid right and wrong. The presentation may also take a more summarizedform, and can roll in data from multiple different incidents, such asall recent incidents of a particular type for a particular rescuer(e.g., all incidents in which a victim suffered a severe sudden cardiacarrest or similar trauma). For example, using the −5 to +5 scoringtechnique described above, a supervisor may be presented with scores fora dozen recent incidents for a rescuer, and may notice that the scoresare generally below 0. The supervisor may then determine to provide therescuer with training in being more aggressive (i.e., providing harderchest compressions, and reacting more quickly to prompts during a CPRinterval).

FIG. 4 is a swim lane diagram of a process for sharing CPR performancedata between various sub-systems in a larger healthcare system. Ingeneral, the process discussed here is similar to those discussed above,though actions performed on particular components of a larger system areshown in more detail to indicate examples of a manner in which suchactions may be performed in one implementation.

The process begins at an accident scene, were a rescuer has deployedequipment from a rescue vehicle, such as a defibrillator and anassociated computing device such as a tablet computer, that maycommunicate with the defibrillator through a wireless data connection.At boxes 402, 404, the two devices are powered up by the rescuer, andwhen they have performed initial activities to become active, they mayautomatically establish a data connection, such as by performingBLUETOOTH pairing between the devices (boxes 406, 408). The rescuer maythen enter patient information, at box 410, into the tablet computer,such as basic information regarding the condition of the patient, bloodpressure and pulse for the patient, and gender of the patient.Information such as blood pressure and pulse may be recordedautomatically by the tablet, such as by way of wired or wirelessconnection with tools for taking the victim's blood pressure and pulse.

At box 414, the rescuer connects sensors to the patient. For example,the rescuer may open a short of a patient and place defibrillation padson the patient. The defibrillation pads may also include ECG electrodesfor sensing cardiac activity of the patient. At this point, thedefibrillator may begin performing according to standard protocols fordelivering care to a patient, such as by analyzing cardiac activity ofthe patient. Such action may also lead to the rescuer performing chestcompressions and other CPR activities on the patient. Thus, at box 422,the defibrillator may begin capturing CPR data, such as depth and rateof compressions data and other data discussed above. Also, thedefibrillator may identify the beginning point for each interval orcycle in the performance of CPR, so as to associate the data with aparticular cycle. At box 424, the defibrillator generates, displays, andtransmits a report regarding data that is being captured from theperformance of CPR. Such a report may take a variety of forms. Forexample, the report may simply indicate initial or primary parametersthat are being captured in real time, and the reporting for thoseparameters may be continuously updated such as every second or portionof a second. Later, the report may include such real-time data, but mayalso include summarized, secondary data for one or more CPR intervals orfor an entire time period of an incident.

At various points in time, the defibrillator may also transfer data forgenerating similar reports to the tablet computer, and the tabletcomputer may display information related to the provision of CPR to thepatient, and may also to further transmit the data to a computing devicein n area of an emergency room where the victim is to be taken (box426). The information may then be displayed as a report in the emergencyroom. The report for the emergency room may take the same form ordifferent forms than that shown on the defibrillator or the tabletcomputer. For example, if one is to assume that the viewer in theemergency room can give less attention to the report than can therescuer, the emergency room report may provide less information and beupdated less frequently than is the report on the defibrillator or thetablet computer. Particular values that are shown in each report, thefrequency with which they are updated, the manner in which they aredisplayed, and the order in which they are displayed may vary dependingon the particular application and the needs of the particular users.

At box 434, the defibrillator identifies that the incident has ended.For example, if no ECG signals are received for a predetermined periodof time, the defibrillator may assume that it has been disconnected fromthe victim and that it will not be used on the victim again. Othermechanisms for determining that an incident has ended are discussedabove. When such a determination is made, the defibrillator may transferits remaining data to the tablet computer and may also generate asummary of the incident and transmit that summary to the tablet computer(box 438). At box 446, the tablet computer displays the summary and alsotransmits information for the summary to a central server system. Suchtransmission may be directed toward providing a semi-permanent orpermanent record regarding the care that was provided to the victim.

Thus, at box 450, the central server system processes the informationreceived from the tablet computer and stores information about theincident. In certain embodiments, all or substantially all of theinformation captured by the defibrillator may be stored. Where spacelimitations or other considerations prevail, summary information may bestored. For example, average values for various parameters may be storedfor each cardiac or CPR interval, rather than storing raw values formuch smaller but more numerous time segments within each interval.

At some later date, the rescuer or another individual may be interestedin analyzing the data that was saved for the particular incident or agroup of incidents. Therefore, at box 452, when such a request isreceived by the central server system, the system may serve responses tothe request for data about the incident or other incidents. At the timeof serving the data for the incident, the central server system maygenerate one or more additional reports for presenting the informationabout the incident or incidents. For example, graphs for each incidentat which a particular rescuer acted may be displayed side-by-side, andtrend lines or other trend features may be displayed, so that theprogression in the skills of a rescuer may be judged, and a reviewer orthe rescuer may determine whether the rescuer needs to adjust his or herapproach to providing care in a rescue situation.

FIG. 4 shows an example of a generic computer device 400 and a genericmobile computer device 450, which may be used with the techniquesdescribed here. Computing device 400 is intended to represent variousforms of digital computers, such as laptops, desktops, workstations,personal digital assistants, servers, blade servers, mainframes, andother appropriate computers. Computing device 450 is intended torepresent various forms of mobile devices, such as personal digitalassistants, cellular telephones, smartphones, and other similarcomputing devices. The components shown here, their connections andrelationships, and their functions, are meant to be exemplary only, andare not meant to limit implementations of the inventions describedand/or claimed in this document.

Computing device 400 includes a processor 402, memory 404, a storagedevice 506, a high-speed interface 408 connecting to memory 404 andhigh-speed expansion ports 410, and a low speed interface 412 connectingto low speed bus 414 and storage device 406. Each of the components 402,404, 406, 408, 410, and 412, are interconnected using various busses,and may be mounted on a common motherboard or in other manners asappropriate. The processor 402 can process instructions for executionwithin the computing device 400, including instructions stored in thememory 404 or on the storage device 406 to display graphical informationfor a GUI on an external input/output device, such as display 416coupled to high speed interface 408. In other implementations, multipleprocessors and/or multiple buses may be used, as appropriate, along withmultiple memories and types of memory. Also, multiple computing devices400 may be connected, with each device providing portions of thenecessary operations (e.g., as a server bank, a group of blade servers,or a multi-processor system).

The memory 404 stores information within the computing device 4500. Inone implementation, the memory 404 is a volatile memory unit or units.In another implementation, the memory 404 is a non-volatile memory unitor units. The memory 404 may also be another form of computer-readablemedium, such as a magnetic or optical disk.

The storage device 406 is capable of providing mass storage for thecomputing device 400. In one implementation, the storage device 406 maybe or contain a computer-readable medium, such as a floppy disk device,a hard disk device, an optical disk device, or a tape device, a flashmemory or other similar solid state memory device, or an array ofdevices, including devices in a storage area network or otherconfigurations. A computer program product can be tangibly embodied inan information carrier. The computer program product may also containinstructions that, when executed, perform one or more methods, such asthose described above. The information carrier is a computer- ormachine-readable medium, such as the memory 404, the storage device 406,memory on processor 402, or a propagated signal.

The high speed controller 408 manages bandwidth-intensive operations forthe computing device 400, while the low speed controller 412 manageslower bandwidth-intensive operations. Such allocation of functions isexemplary only. In one implementation, the high-speed controller 408 iscoupled to memory 4504, display 416 (e.g., through a graphics processoror accelerator), and to high-speed expansion ports 410, which may acceptvarious expansion cards (not shown). In the implementation, low-speedcontroller 412 is coupled to storage device 406 and low-speed expansionport 414. The low-speed expansion port, which may include variouscommunication ports (e.g., USB, Bluetooth, Ethernet, wireless Ethernet)may be coupled to one or more input/output devices, such as a keyboard,a pointing device, a scanner, or a networking device such as a switch orrouter, e.g., through a network adapter.

The computing device 400 may be implemented in a number of differentforms, as shown in the figure. For example, it may be implemented as astandard server 420, or multiple times in a group of such servers. Itmay also be implemented as part of a rack server system 424. Inaddition, it may be implemented in a personal computer such as a laptopcomputer 422. Alternatively, components from computing device 400 may becombined with other components in a mobile device (not shown), such asdevice 450. Each of such devices may contain one or more of computingdevice 400, 450, and an entire system may be made up of multiplecomputing devices 400, 450 communicating with each other.

Computing device 450 includes a processor 452, memory 464, aninput/output device such as a display 454, a communication interface466, and a transceiver 468, among other components. The device 450 mayalso be provided with a storage device, such as a micro drive or otherdevice, to provide additional storage. Each of the components 450, 452,464, 454, 466, and 468, are interconnected using various buses, andseveral of the components may be mounted on a common motherboard or inother manners as appropriate.

The processor 452 can execute instructions within the computing device450, including instructions stored in the memory 464. The processor maybe implemented as a chipset of chips that include separate and multipleanalog and digital processors. The processor may provide, for example,for coordination of the other components of the device 450, such ascontrol of user interfaces, applications run by device 450, and wirelesscommunication by device 450.

Processor 452 may communicate with a user through control interface 458and display interface 456 coupled to a display 454. The display 454 maybe, for example, a TFT LCD (Thin-Film-Transistor Liquid Crystal Display)or an OLED (Organic Light Emitting Diode) display, or other appropriatedisplay technology. The display interface 456 may comprise appropriatecircuitry for driving the display 454 to present graphical and otherinformation to a user. The control interface 458 may receive commandsfrom a user and convert them for submission to the processor 452. Inaddition, an external interface 462 may be provide in communication withprocessor 452, so as to enable near area communication of device 450with other devices. External interface 462 may provide, for example, forwired communication in some implementations, or for wirelesscommunication in other implementations, and multiple interfaces may alsobe used.

The memory 464 stores information within the computing device 450. Thememory 464 can be implemented as one or more of a computer-readablemedium or media, a volatile memory unit or units, or a non-volatilememory unit or units. Expansion memory 474 may also be provided andconnected to device 450 through expansion interface 472, which mayinclude, for example, a SIMM (Single In Line Memory Module) cardinterface. Such expansion memory 474 may provide extra storage space fordevice 450, or may also store applications or other information fordevice 450. Specifically, expansion memory 474 may include instructionsto carry out or supplement the processes described above, and mayinclude secure information also. Thus, for example, expansion memory 474may be provide as a security module for device 450, and may beprogrammed with instructions that permit secure use of device 450. Inaddition, secure applications may be provided via the SIMM cards, alongwith additional information, such as placing identifying information onthe SIMM card in a non-hackable manner.

The memory may include, for example, flash memory and/or NVRAM memory,as discussed below. In one implementation, a computer program product istangibly embodied in an information carrier. The computer programproduct contains instructions that, when executed, perform one or moremethods, such as those described above. The information carrier is acomputer- or machine-readable medium, such as the memory 464, expansionmemory 474, memory on processor 452, or a propagated signal that may bereceived, for example, over transceiver 468 or external interface 462.

Device 450 may communicate wirelessly through communication interface466, which may include digital signal processing circuitry wherenecessary. Communication interface 466 may provide for communicationsunder various modes or protocols, such as GSM voice calls, SMS, EMS, orMMS messaging, CDMA, TDMA, PDC, WCDMA, CDMA2000, or GPRS, among others.Such communication may occur, for example, through radio-frequencytransceiver 468. In addition, short-range communication may occur, suchas using a Bluetooth, WiFi, or other such transceiver (not shown). Inaddition, GPS (Global Positioning System) receiver module 470 mayprovide additional navigation- and location-related wireless data todevice 450, which may be used as appropriate by applications running ondevice 450.

Device 450 may also communicate audibly using audio codec 460, which mayreceive spoken information from a user and convert it to usable digitalinformation. Audio codec 460 may likewise generate audible sound for auser, such as through a speaker, e.g., in a handset of device 450. Suchsound may include sound from voice telephone calls, may include recordedsound (e.g., voice messages, music files, etc.) and may also includesound generated by applications operating on device 450.

The computing device 450 may be implemented in a number of differentforms, as shown in the figure. For example, it may be implemented as acellular telephone 480. It may also be implemented as part of asmartphone 482, personal digital assistant, or other similar mobiledevice.

Various implementations of the systems and techniques described here canbe realized in digital electronic circuitry, integrated circuitry,specially designed ASICs (application specific integrated circuits),computer hardware, firmware, software, and/or combinations thereof.These various implementations can include implementation in one or morecomputer programs that are executable and/or interpretable on aprogrammable system including at least one programmable processor, whichmay be special or general purpose, coupled to receive data andinstructions from, and to transmit data and instructions to, a storagesystem, at least one input device, and at least one output device.

These computer programs (also known as programs, software, softwareapplications or code) include machine instructions for a programmableprocessor, and can be implemented in a high-level procedural and/orobject-oriented programming language, and/or in assembly/machinelanguage. As used herein, the terms “machine-readable medium”“computer-readable medium” refers to any computer program product,apparatus and/or device (e.g., magnetic discs, optical disks, memory,Programmable Logic Devices (PLDs)) used to provide machine instructionsand/or data to a programmable processor, including a machine-readablemedium that receives machine instructions as a machine-readable signal.The term “machine-readable signal” refers to any signal used to providemachine instructions and/or data to a programmable processor.

To provide for interaction with a user, the systems and techniquesdescribed here can be implemented on a computer having a display device(e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor)for displaying information to the user and a keyboard and a pointingdevice (e.g., a mouse or a trackball) by which the user can provideinput to the computer. Other kinds of devices can be used to provide forinteraction with a user as well; for example, feedback provided to theuser can be any form of sensory feedback (e.g., visual feedback,auditory feedback, or tactile feedback); and input from the user can bereceived in any form, including acoustic, speech, or tactile input.

The systems and techniques described here can be implemented in acomputing system that includes a back end component (e.g., as a dataserver), or that includes a middleware component (e.g., an applicationserver), or that includes a front end component (e.g., a client computerhaving a graphical user interface or a Web browser through which a usercan interact with an implementation of the systems and techniquesdescribed here), or any combination of such back end, middleware, orfront end components. The components of the system can be interconnectedby any form or medium of digital data communication (e.g., acommunication network). Examples of communication networks include alocal area network (“LAN”), a wide area network (“WAN”), and theInternet.

The computing system can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other.

A number of embodiments have been described. Nevertheless, it will beunderstood that various modifications may be made without departing fromthe spirit and scope of the invention. For example, much of thisdocument has been described with respect to ICU monitoring withattending physicians, but other forms of patient monitoring andreporting may also be addressed.

In addition, the logic flows depicted in the figures do not require theparticular order shown, or sequential order, to achieve desirableresults. In addition, other steps may be provided, or steps may beeliminated, from the described flows, and other components may be addedto, or removed from, the described systems. Accordingly, otherembodiments are within the scope of the following claims.

What is claimed is:
 1. A computer-implemented method for providingsummary information for lifesaving activities, the method comprisingsensing one or more activities that are repeatedly and cyclicallyperformed on a victim by a rescuer; identifying a cyclical timinginterval over which performance is to be analyzed for a integer numberof cycles of the one or more activities, and gathering data from thesensing of the one or more activities during the time interval;generating, from analysis of the one or more activities, summary datathat condenses data sensed for the one or more activities into a summaryof the one or more activities; and providing, for display to a user, avisual summary of the performance of the one or more activities over theidentified time interval.
 2. The method of claim 1, wherein the sensorscomprise one or more sensors selected from a group consisting of chestcompression sensors, patient ventilation sensors, and electrocardiogramsensors.
 3. The method of claim 1, wherein providing the visual summaryfor display comprises wirelessly transmitting data about the one or moreactivities from a device that senses the one or more activities to aremote device having a visual display device display.
 4. The method ofclaim 3, wherein the remote device is located in a rescue vehicleproximate to the device that senses the one or more activities.
 5. Themethod of claim 3, wherein the device that senses the one or moreactivities is wirelessly connected to the sensors.
 6. The method ofclaim 3, wherein the remote device is located in a central medicalfacility that is distant from the device that senses the one or moreactivities, and data for generating the visual summary is provided bytransmission through a public data network.
 7. The method of claim 1,wherein the summary comprises a score that indicates by one or morealpha-numeric indicators, a quality level with which the one or moreactivities were performed.
 8. The method of claim 1, wherein the visualsummary is provided for display on multiple devices simultaneously. 9.The method of claim 1, further comprising monitoring electrocardiogramdata of the victim while the one or more activities are occurring, andproviding with a defibrillator at least one of charging thedefibrillator and shocking the victim without manual intervention of arescuer.
 10. The method of claim 1, wherein generating summary datacomprises generating a single data value from information received frommeasurement of two or more distinct actions performed on the victim. 11.The method of claim 1, wherein the summary data includes data thatrepresents a current physical condition of the user.
 12. Acomputer-implemented system for providing summary information forlifesaving activities, the system comprising: a patient monitor havingan interface for receiving signals from one or more patient-connectedsensors; a rescuer performance analysis system programmed using storedinstructions to incorporate data representative of a plurality ofactivities performed on a patient by a rescuer in the form of primaryindications, and to generate secondary indications of the performance ofcardiopulmonary resuscitation on the patient from the data; and one ormore user interfaces to provide audible or visual indications of thegenerated secondary indications.
 13. The system of claim 12, wherein thesystem is arranged to display, simultaneously, the primary indications,and the secondary indications of activity performed on the patient thatare derived from one or more of the primary indications of activitiesperformed on the patient.
 14. The system of claim 13, wherein theprimary indications comprise rate and depth of chest compression, andthe secondary indications comprise average rates and depths of chestcompression over historical time periods.
 15. The system of claim 13,wherein the primary indications comprise real-time values for activitiescurrently being performed on the patient, and the secondary indicationscomprise historical values for corresponding activities previouslyperformed on the patient.
 16. The system of claim 15, wherein theprimary values are presented as real-time data, and the secondary valuesare presented as averages for previous CPR intervals.
 17. The system ofclaim 13, wherein the patient monitor and rescuer performance analysissystem are integrated into a portable patient defibrillator.
 18. Thesystem of claim 13, further comprising a wireless interface arranged totransmit data about the primary and secondary indications to a remotesystem for presentation of graphical representations o the activitiesperformed on the patient.
 19. The system of claim 18, wherein the remotesystem is programmed to identify a rescuer common to multiple incidentsand patients and to provide a display of data that shows performance bythe rescuer across the multiple incidents and patients.
 20. Acomputer-implemented system for providing summary information forlifesaving activities, the system comprising: a patient monitor havingan interface for receiving signals from one or more patient-connectedsensors; means for generating primary and secondary indications ofcardiopulmonary resuscitation on a patent, the primary indications beingdirect representations of data measured from the patent, and thesecondary indications being derived representations generated from oneor more of the primary representations; and one or more user interfacesto provide audible or visual indications of the generated secondaryindications.